cefotaxime and Vomiting

The work-up and initial management of a critically ill neonate is challenging and anxiety provoking for the Emergency Physician. While sepsis and critical congenital heart disease represent a large proportion of neonates presenting to the Emergency Department (ED) in shock, there are several additional etiologies to consider. Underlying metabolic, endocrinologic, gastrointestinal, neurologic, and traumatic disorders must be considered in a critically ill infant. Several potential etiologies will present with nonspecific and overlapping signs and symptoms, and the diagnosis often is not evident at the time of ED assessment.. We present the case of a neonate in shock, with a variety of nonspecific signs and symptoms who was ultimately diagnosed with tachycardia-induced cardiomyopathy secondary to a resolved dysrhythmia. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case highlights the diagnostic and therapeutic approach to the critically ill neonate in the ED, and expands the differential diagnosis beyond sepsis and critical congenital heart disease. Knowledge of the potential life-threatening etiologies of shock in this population allows the Emergency Physician to appropriately test for, and empirically treat, several potential etiologies simultaneously. Additionally, we discuss the diagnosis and management of supraventricular tachycardia and Wolff-Parkinson-White syndrome in the neonatal and pediatric population, which is essential knowledge for an Emergency Physician.

Topics: Acidosis; Acyclovir; Adenosine; Ampicillin; Anti-Arrhythmia Agents; Anti-Bacterial Agents; Antiviral Agents; Cardiomyopathies; Cefotaxime; Electrocardiography; Emergency Service, Hospital; Feeding Behavior; Fluid Therapy; Glucose; Humans; Hypoglycemia; Hypotension; Hypoxia; Infant, Newborn; Lethargy; Male; Propanolamines; Propranolol; Shock; Tachycardia; Tachycardia, Supraventricular; Vomiting; Wolff-Parkinson-White Syndrome

An 11-month-old boy presented with a 2-day history of non-specific symptoms and a zygomatic haematoma. With aetiology uncertain after admission clerking and blood tests, a CT head scan was arranged for suspected traumatic injury and revealed a retropharyngeal abscess (RPA) with significant airway narrowing in the transverse plane. The patient received urgent intraoral abscess drainage and bilateral tonsillectomy in theatre. This case highlights the need for a high index of suspicion regarding RPAs. These abscesses have potentially fatal sequelae and are difficult to diagnose in the infant paediatric population.

Topics: Acetaminophen; Analgesics, Non-Narcotic; Anorexia; Anti-Bacterial Agents; Cefotaxime; Dexamethasone; Drainage; Hematoma; Humans; Infant; Male; Metronidazole; Postoperative Care; Retropharyngeal Abscess; Tomography, X-Ray Computed; Tonsillectomy; Tonsillitis; Treatment Outcome; Vomiting

Fungal rhinosinusitis is being recognized and reported with increasing frequency over the last two decades worldwide. Intracranial extension is the most dreaded complication of fungal sinusitis with high mortality rates. We report a case of chronic rhinosinusitis in a 55-year-old diabetic male, caused by Fusarium species. The patient was diagnosed as a case of chronic left maxillary sinusitis with cavernous sinus thrombosis. The sinus lavage showed fungal elements on direct microscopic examination and culture revealed growth of Fusarium species within 4 days of incubation. Conservative therapy with IV amphotericin B resulted in favorable outcome of the patient. This is an extremely rare case where cavernous sinus thrombosis occurred as a complication secondary to Fusarium species rhinosinusitis.

Topics: Amphotericin B; Cavernous Sinus Thrombosis; Cefotaxime; Chronic Disease; Diabetes Mellitus, Type 2; Diplopia; Disease Susceptibility; Fusariosis; Fusarium; Headache; Humans; Insulin; Magnetic Resonance Imaging; Male; Maxillary Sinusitis; Middle Aged; Photophobia; Rhinitis; Vomiting

The chronic intravenous toxicity of cefodizime sodium (THR-221) was studied in beagle dogs. Groups of 6 males and 6 females were treated with THR-221 at doses of 0 (saline), 200, 400, 800 and 1600 mg/kg/day for 6 months. The THR-221 related symptoms were vomiting, excessive drinking behavior and salivation. The paleness of the visible mucosa and discoloration of vascular color by funduscopy due to systemic anemia were observed in one animal each of 800 and 1600 mg/kg/day groups. Body weight was depressed transiently or continuously in a few animals of 400-1600 mg/kg/day groups. The hematological, serum chemical and urinalysis findings in a few animals of 400-1600 mg/kg/day groups revealed decreases in RBC count, PCV and hemoglobin, an increase in reticulocyte count, a decrease in WBC count, a decrease in platelet count, slight increase in TP, and albumin, a decrease in AlP, and an increase in urinary Na. Light microscopically, deposition of hemosiderin and increased extramedullary hematopoiesis in the liver and spleen, and deposition of fibroid substance in the white pulp of the spleen and diffuse fibrosis in the bone marrows were detected in a few animals of 800 and 1600 mg/kg/day groups. Electron microscopically, no significant toxic changes were observed. The maximum nontoxic doses of THR-221 are estimated as 200 mg/kg/day in male and less than 200 mg/kg/day in female.

Topics: Anemia; Animals; Blood Proteins; Bone Marrow; Cefotaxime; Dogs; Drinking; Female; Fibrosis; Hematopoiesis; Injections, Intravenous; Kidney Tubules; Liver; Male; Retinal Vessels; Salivation; Sodium; Spleen; Vomiting

A subacute toxicity study of cefodizime sodium (THR-221), a new cephem antibiotics, was carried out using male and female beagle dogs. THR-221 was intravenously administered to the dog at dose levels of 500, 1000 and 2000 mg/kg/day for 5 weeks, followed by 4 weeks recovery period. Cefotetan (CTT) as a reference drug was administered in the same manner at a dose level of 2000 mg/kg/day. The summarized results obtained are as follows: 1. Vomiting and salivation were observed in dogs given 1000 and 2000 mg/kg/day of THR-221. However, it caused no deaths or significant effects on body weight and food consumption in all groups treated with THR-221. 2. No toxicological changes associated with the administration of THR-221 were found in urinary and hematological examinations. 3. In serum biochemical examinations, increase or tendencies of increase of albumin and A/G ratio, probably due to the antibacterial action of THR-221, were detected at all dose levels of THR-221. 4. There were no dose-related changes in hepatic and renal function, fecal occult blood, ophthalmological, electrocardiographic and auditory examinations, absolute and relative organ weights. 5. Histopathological examinations revealed fibrosis or granulation in perivascular area of injection sites, particularly in males given 2000 mg/kg/day of THR-221. 6. After 4 weeks of recovery period, above-mentioned changes were generally disappeared and it was suggested that these were reversible ones. 7. In groups treated with CTT (2000 mg/kg/day), damages were recognized mainly in erythron values, liver and kidney, as compared with the same dose of THR-221. Therefore the toxicity of THR-221 was less than that of CTT. 8. From these results, the non toxic effective dose level and the toxic dose level of THR-221 were estimated to be 500 mg/kg/day and more than 2000 mg/kg/day respectively, for male and female dogs.

Topics: Animals; Cefotaxime; Cefotetan; Dogs; Female; Fibrosis; Granulation Tissue; Injections, Intravenous; Male; Salivation; Serum Albumin; Serum Globulins; Veins; Vomiting